HomeMy WebLinkAboutScan_0002SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
K Not Applicable
Address:
City: State:
Zip: Phone
Address:
STATE OF FLORIDA
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City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY;
Name:
Not Applicable
Address:
City:
City:
Name of perso aking statement
Zip: Phone:
Zip: Phone:
Type of Identification
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced ,prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. '
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Rev. 8/2/1.7
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Signature of Owne / Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDAr,
STATE OF FLORIDA
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COUNTY OF ` ct�—
COUNTY OF
The forgoing instrum t was aQ iowledge efore me
The forgoing instrume t was a knowledge efore me
16
this day of ^c4ilt , 20AX by
this day of C 20 by
Name of peaking statement
rso �OR
Name of perso aking statement
Personally Known Produced Identification
Personally Known 012 Produced Identification
Type of Identification
Type of Identification
Produced
Produced
i
(Signature of Notary Public- Stat f rida }
(Signature of Notary Public- State of Florida }
— public State of Florida (Seal)
Com ealj
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Notary Public State of Florid'
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Suzette Ritchie
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Expires 12!1212
21
5
FRONT
ZONING
SUPERVISOR
PLA -
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/1.7